In this video I talk about how people's fear of dyskinesia is disproportional to the actual clinical complaint of dyskinesia. While this is true, I didn't do as good a job as I would have liked acknowledging that some people do have get severe, debilitating dyskinesia. (For instance, I had a patient tear a tendon in their knee in a fit of dyskinesia!) It can be severe and problematic, but the majority of the time these movements are annoying, but not debilitating.

Non-oral delivery systems for L-dopa:

Duopa pump-

I have a handful of patients that have the pump and they are all happy with it. The surgeons are still figuring out some tubing issues (at least in Seattle) and it's expensive. It does seem my patients with the Duopa pump are more frequently dyskinestic & I don't have much experience messing around with drug delivery. I'm not sure if my experience reflects the larger population. It does seem that people with the pump aren't as susceptible to protein interference, but I don't think that's been formally studied.

Inhaled levodopa-

Inbrija (inhaled levodopa) has recently become available in the US. (Disclosure: I bought stock in Accorda; I want to invest in strategies that promote the non-oral delivery of PD medications.) Also expensive, this drug is a game-changer for PwP. If you ever find yourself in situations where the oral levodopa is not kicking in (e.g. on a flight where you're given a choice of 2 high-protein meals and you find the meds aren't kicking in and you need to get up to use the restroom), this is an ideal drug. Like Apokyn, it allows your body rapid access to dopamine in a way that entirely bypasses your intestinal track. Even if you only use this once a month, I do think it's a valuable tool for people that experience OFF times.